Predicting HIV testing decisions

OBJECTIVE: To evaluate previous HIV testing history among residents of a community in Trinidad so as to identify predictors of HIV testing decisions. DESIGN AND METHODS: A sample of 186 respondents aged 18- 85 years was surveyed using stratified random sampling. Through interviewer administered questionnaire information was acquired on HIV testing history, awareness of HIV testing and treatment information, fear of HV testing, stigma towards persons living with HIV, and perception of risk. A simultaneous logistic regression was used to model respondents’ decision to have an HIV test. RESULTS: There were 185 respondents (M 92, F 93). Respondents with higher levels of awareness are 1.109 times more likely to have had an HIV test; younger respondents were 0.945 times more likely to have had an HIV test than older respondents. Respondents who reported higher levels of perception of risk were 0.924 times less likely to have had an HIV test. CONCLUSION: Younger persons and persons with higher levels of awareness of HIV testing and treatment information were more likely to decide to be HIV tested while persons reporting higher levels of perception of risk were less likely to be tested. Interventions to build awareness of HIV testing and treatment should be designed to encourage HIV testing among older persons. A routinized approach to HIV testing has potential to shift the focus from HIV prevention to health and well-being and dismantle barriers which prevent people from realising the real risks of HIV infection.

Why do some women bypass their family physician in seeking preventive care?: a qualitative study [abstract]

The Health Watch clinic at Women's College Hospital, Toronto, provides screening and preventive services primarily to women in Ontario. These services can be seen as a duplication of those that can be provided by family physicians. Nevertheless, some Ontario women continue to bypass their family physicians and attend this clinic. This study was done to understand the decision-making processes women go through in deciding to bypass their family physician when seeking preventive health services and to understand which features of this model of preventive care are so attractive. Seventeen women attending the Health Watch Clinic agreed to participate. In-depth interviews were carried out until saturation was achieved. The interviews were taped and later transcribed. The data were analyzed using qualitative methods, specifically, grounded in theory. Emergent themes were extracted while listening to tapes and reading transcripts. Themes were discussed between researchers and an agreement was arrived at. These themes were relayed back to participants to confirm interpretation. The emerging themes suggest that women bypass the family physician for several reasons, including: "Women negative" experiences, the inherent qualities of the woman, such as her locus of control, normative influences, and perceived positive aspects of the Health Watch Clinic and the Women's College Hospital. The findings suggest that women who bypass their family doctor have generally had a negative experience with the traditional healthcare system. The women in this study were highly educated with high internal motivation and tended to have extensive family and friend support and advice regarding health matters. (AU)

Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking

OBJECTIVES: To assess sexually transmitted diseases (STD) among women attending Jamaican family planning clinics and to evaluate decision models as alternatives to STD laboratory diagnosis. METHODS: Women attending two family planning clinics in Kingston were interviewed and tested for syphilis seroreactivity using toluidine red unheated serum test and Treponema pallidum haemagglutination, for gonorrhoea using culture, for chalamydial infection using enzyme linked immunoassay, and for trichomoniasis using culture. Urine was tested with leucocyte esterase dipstick (LED). The women were treated based upon a clinical algorithm. Computer simulations explored the use of risk inclusive decision models for detection of cervical infection and/or trichomoniasis. RESULTS: Among 767 women, 206 (26.9 percent) had at least one STD. The prevalence of gonorrhoea was 2.7 percent: chlamydial infection 12.2 percent, gonococcal and/or chlamydial cervical infection 14.1 percent; trichomoniasis 11.5 percent; syphilis seroreactivity 5.9 percent. The clinical algorithm was 3.7 percent sensitive and 96.7 percent specific in detecting cervical infection. Detection of cervical infection and/or trichomoniasis was 63.5 percent sensitive and 60.6 percent specific using LE and 57.7 percent sensitive and 46.2 percent specific using the risk inclusive algorithm employed in Jamaica STD clinics. Either cervical friability or LED (+) or family planning clinic attender less than 25 years old with more than one sexual partner in the past year was 72.5 percent sensitive and 53.3 percent specific. The positive predictive values of the STD clinic algorithm, LED, and two developed decision models ranged from 25.0 percent to 33.4 percent to detect cervical infection and/or trichomoniasis in these women. CONCLUSION: STDs were quite prevalent in these mainly asymptomatic family planning clinic attenders. None of the evaluated decision models can be considered a good alternative to case detection using laboratory diagnosis. Appropriate detection tools are needed. In the meantime, available STD control strategies should be maximised, such as promotion of condom use; adequate treatment of symptomatic STD patients and partners; and education of women and men (AU)

Contraceptive decision-making among adolescents in secondary schools in Kingston and St. Andrew, Jamaica

The study investigated the factors which influence contraception decision-making among Grade 9 or Form 3 students attending secondary schools within Kingston and St. Andrew (Corporate Area). A cross-sectional study which involved a random sample of 220 students drawn from six schools, (one all-female, one all-male and four co-educational) was carried out during the month of March 1997. The results showed that there was a significant difference between the number of females and males who were attending school. It was observed that the students did not have good knowledge on fertility but indicated that they were well aware of the condom and the pill. Closer examination to validate this knowledge, proved to be the corollary of what they had indicated, concerning the use of the pill. Generally, students had good attitude toward fertility and contraception but seemed to be unclear about the difference between abortion and contraception. Only a small percentage of them used a contraceptive, of which more males than females used a method, hence the condom was found to be used most popularly among this sub-group. The pharmacy remained the main source of providing teenagers with contraceptives, but students' preferences were the Doctor's Office and the Family Planning Clinic. The level of counselling was average and students main reason for their choice was related to health reasons. A significant number of males than females indicated that they had sufficient information to choose a method and 58 percent of them had been exposed to FLE, and 84 percent had good to fair knowledge on fertility and contraception. A fairly large percentage of students were dissatisfied with the FLE programme in their schools. Students suggested various sources from which they obtained information and cited the media (1st) and youth group as the most acceptable place where sex education information should be made available. A large majority of the respondents (96.7 percent) did not want to have a child now. The reasons for their choices were based on their perception of pre-disposing and enabling factors. The majority of students, least considered educational and future job benefits as part of their decision-making concerning contraception. The majority of the students did not want to enter into motherhood or. fatherhood, at this stage of their lives. But the result showed that they were lacking in several of the essential requirement necessary for decision-making.(Au)

Working women's sexual risk taking in Jamaica

Although the rates of HIV are increasing among female populations in developing countries, there is little information available about factors influencing sexual risk taking among working class women. This paper describes some of the issues discussed by two groups of 58 women working in Jamaica: Informal Commerical Importers and women working in the Free Zone. These women discuss their economic vulnerability, expectations about the role of men as provides, multiple partners, perception of children as resources and concern about physical abuse as factors that could influence decisions about condom use. The implications of these findings are discussed for their impact of intervention programs targeting working class women in Jamaica.(AU)

The role of applied research in donor-supported public health programmes in developing countries - abstract

The basic goal of scientific inquiry, whether in individual patient care or in health practice, is to replace intuitive thinking or ad hoc decision-making with methodological tools for appropriate decision-making. Two objectives of the USAID-supported African Child Survival Initiative - Combatting Childhood Communicable Disease (ACSI-CCCD) have been to provide data necessary for programmatic needs and to develop indigenous research capability among African counterparts and institutions. The twelve-year experience of applied research in ACSI-CCCD was reviewed through project documents, research reports and proposals, and focus groups, individual interviews and on-site visits with African investigators and programme managers. Research undertaken with CCCD support was compared to the typology of Feachem et al which classifies the priorities for developing country research in hiearchical fashion. Particular attention was paid to evaluating programme or policy impact or research findings, benefits to local institutions or individual researchers, and perceived value of the research proces or results to local, national or regional health objectives. Over 250 research activities in 18 countries received CCCD support from the project's inception. Significant accomplishments were achieved in strengthening research capacity as well as advancing programmatic objectives, despite the conflicting nature of these goals. Identified strengths of the CCCD research component were its close links to local programmes and programme managers, responsiveness to local priorities, availability of local review and funding mechanisms, policy relevance, and flexibility in the face of changing circumstances. Skills transfer and availability of technical assistance were also highlighted. Weaknesses identified included inadequate monitoring and supervision of research activities (particularly in remote or widespread geographical locations), absence of a clear agenda or priorities for indigenous research, sometimes conflicting objectives of donors and local programme managers, and relatively small achievements in institutional strengthening. Long-term benefits in donor-sponsored applied research will require acknowledging a clear distinction between "promoting research" and "developing researchers". Both short-term training, such as workshops and mentoring relationships, and formal postgraduate training are necessary to establish an acceptable and sustainable research infrastructure for health services in developing countries (AU)

Ethical issues in intensive care: a look to the 90s - abstract

With the advent of Intensive Care Units has come the ability to offer life support technology to patients with failure of the vital systems, patients who would die without this type of support. Ethical decisions have now to be made as to the selection of patients who would have the optimum response to such technology. Such decisions are not easily made as the factors on which they are sometimes based are neither objective nor well-defined. These factors are not subject to patients pathology only, but als to the availability of the necessary equipment and personnel. Although such decisions have to be made in every country offering intensive care, they become more important in those countries with scarce resources, e.g., the West Indian Islands. In addition to the above issues, newer issues will be discussed, e.g., the impact of the AIDS patient on ICU personnel, "Living Wills", etc (AU)

The delivery of health care in Jamaica and its implications for public policy

This is a study of the system of health care delivery in Jamaica between the years immediately following the emancipation of slavery (1838) and the end of the first sixteen years of the nation's political independence (1978). While this enquiry is by no means exhaustive, it has attempted to examine in historical perspective some of the dynamics of the public policy-making processes with particular reference to the area of health care delivery. Throughout the research an attempt was made to describe, analyse and explain some of the causes and effects of government's activities in this particular area of public administration. The investigations sought to identify centres of decision-making within the system and to establish the nature of the relationships between the environmental forces, - national and international - and the actors in the political system in the formulation and implementation of public policy. A fundamental aspect of this paper is its focus on the effects of political 'development' on the process of change in the system of social policy. This should provide a basis on which to question some of the theoretical assumptions about how public policy 'is' or 'ought to be' made, as well as assist students of public administration to draw some conclusions on the applicability of theoretical 'models' of decision-making to the policy-making processes in a developing country such as Jamaica (AU)

The management of health services in Jamaica - a case study in modernization

This is a study of the management of health services in Jamaica to identify the challenges created for the bureaucracy in the delivery of health services, to assess the effectiveness and efficiency with which these challenges have been met and to propose a broad framework for an improved health management system. The study provided the opportunity to test the following hypotheses: a) Health policies in Jamaica have been a reflection and product of the country's social stratification; b) Decision-making and the selection of health priorities have been determined without adequate information and analysis; c) The government adminsitrative machinery for the delivery of health care is a product of the colonial era and lacks the dynamism needed for modernization of the health services; d) Health programs are not adequately integrated into national development programs. The methodology used was to examine the literature on the theory of public administration, with emphasis on developing countries and particularly the English-speaking Caribbean, and to utilize the concepts of Systems Analysis, Elitism and Incrementalism in analysing the health policies pursued. The concept of "modernization" was examined in depth with emphasis on the works of Fred Riggs and Third World writers, particularly G.E. Mills, Edwin Jones, Walter Rodney and George Beckford. Against this conceptual framework, guidelines for modernization of the health services were developed. The examination of the health management system comprised an analysis of the historical roots and traditional cahracteristics in the management of the health services, the existing system of public administration in Jamaica and the administration of the health services (specifically the Ministry of Health and Environmental Control). In the main, the analysis substantiated the hypotheses stated at the beginning of the study. On the basis of this analysis a proposed management system for the health services was developed with the following basic components: a) an organization structure with clearly defined lines of authority and responsibility emphasizing the levels of policy determination, policy execution, normative and supportive and operational; b) the establishment of a planning mechanism supported by a relevant and timely information system emphasizing health as part of socio-economic development, and working in close collaboration with the National Planning Agency and international organizations; c) the development of health policies relevant to health needs; d) the provision of greater responsibility and authority to operational levels; e) the provision of an integrated system of health care based on clearly defined levels of care; f) the establishment of "institutions" to provide for greater community participation in the planning and implementation of health services (AU)

National food and nutrition policy in the Commonwealth Caribbean

For many years the Governments of the Caribbean have made concerted efforts to improve the nutrition of their peoples. Nevertheless, the idea that there should be a coordinated food and nutrition policy at the national level is relatively new. This article discusses what a national food and nutrition policy should be, ways to formulate it, what scope it should have, some ingredients essential for its success, and the government machinery needed to make it work. (AU)

Analysis of the Jamaican governments policy on compulsory immunization against selected diseases of children 0-7 years of age

Analyses several theories of public policy decision-making process as a background to the Jamaican government's decision to implement a compulsory immunization programme. Contends that policy programme with its objective to target the 0-7 age group evolved from WHO's Expanded Programme on Immunization, was assisted by PAHO and extensively communicated to health staff and clientele after its enactment in parliament. Examines the problems of policy implementation as identified by staff and clientele and the trends in immunization and the fact that poorer mothers than the generally educated ones were embracing the programmes. Recommends maintenace of momentum of present policy to achieve one hundred percent average, more national health education, deployment of health aides into communities to reach on deliquent mothers and that all immunization be done at government health centres. (AU)